Vasitis nodosa

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Vasitis nodosa
Diagnosis in short

Vasitis nodosa (left side of image). H&E stain.

LM tubules with sperm
LM DDx prostate carcinoma, metastatic adenocarcinoma
IHC PSA -ve, PSAP -ve
Site vas deferens

Clinical history (usually) previous vasectomy
Prognosis benign
Vasitis nodosa
External resources
EHVSC 10185

Vasitis nodosa, abbreviated VN, is a common complication of vasectomy that is seldomly seen by pathologists. It is seen by pathologists in the context of vasovasostomy.

General

  • Classically seen in a specimen from a vasovasostomy (vasectomy reversal).[1]
    • Seen in association with other surgical procedures.
    • May be seen in the context of infertility (without prior vasectomy).
  • Some similarity to salpingitis isthmica nodosa.[1]

Gross

  • Mass.

Microscopic

Features:[1]

  • Tubules in wall of vas deferens.
    • Lined by columnar/cuboidal epithelium.
      • May have mitotic activity.
      • Nucleoli.
      • Contain sperm - small, dark staining, teardrop-shaped (~1 micrometer) - key feature.
        • The tail is rarely seen completely in the plane of section.
  • +/-Sperm granulomas.
    • Histocytes - abundant foamy cytoplasm.
    • Sperm - small, dark staining, teardrop-shaped (~1 micrometer).

DDx:

Notes:

Images

www:

IHC

Features:[4]

  • PSA -ve.
  • CK7 +ve
  • CK34betaE12 +ve.
  • Vimentin +ve.
  • CK19 +ve.

Others:

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Right Vas Deferens, Excision:
     - Vasitis nodosa.

Block letters

A. VAS DEFERENS WITH GRANULOMA, RIGHT, VASOVASOSTOMY:
- VASITIS NODOSA AND SPERM GRANULOMAS.
- COMPLETE CROSS SECTION OF VAS DEFERENS.

B. VAS DEFERENS WITH GRANULOMA, LEFT, VASOVASOSTOMY:
- VASITIS NODOSA AND SPERM GRANULOMAS.
- COMPLETE CROSS SECTION OF VAS DEFERENS.

Micro

The sections show one unremarkable cross section of the vas deferens and several sections with a histocytic response at the external aspect of the vas deferens' muscle layers. The histocytes are aggregated and contains bland tubular structures with sperm.

The tubular structures are POSITIVE for CK7 and CK34betaE12, and NEGATIVE for PSA. CD68 marks the histiocytes.

See also

References

  1. 1.0 1.1 1.2 Hirschowitz, L.; Rode, J.; Guillebaud, J.; Bounds, W.; Moss, E. (Apr 1988). "Vasitis nodosa and associated clinical findings.". J Clin Pathol 41 (4): 419-23. PMC 1141468. PMID 3366928. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1141468/.
  2. Balogh, K.; Travis, WD. (Apr 1985). "Benign vascular invasion in vasitis nodosa.". Am J Clin Pathol 83 (4): 426-30. PMID 3984936.
  3. URL: http://medical-dictionary.thefreedictionary.com/elastosis. Accessed on: 26 September 2011.
  4. Sakaki, M.; Hirokawa, M.; Horiguchi, H.; Wakatsuki, S.; Sano, T. (Apr 2000). "Vasitis nodosa: immunohistochemical findings--case report.". APMIS 108 (4): 283-6. PMID 10843416.